Guest guest Posted August 18, 2005 Report Share Posted August 18, 2005 I'm not sure what other states do in regards to RSS but in Minnesota they have a program called TEFRA (part of MA) that covers all the costs for my RSS daughter, including growth hormone and needles. When I had her on a regular HMO, the co-pays literally bankrupted. I applied for MA for my daughter, got her certified as disabled due to her feeding needs and have had no worries since. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2005 Report Share Posted November 4, 2005 Hi Nky_guy77 My OMS is out of network for my insurance (an employer self funded program). His fee is $14000, of which I have to pay 20% or $700. The maximum out of pocket I have with our plan is $1000. I lucked out that the hospital is in our network, so I have no copay. So I am thinking that I will just have to pay $700. At most I would pay $1000 for the surgery itself. I did not have any coverage for the braces, which was $5800. You might want to check with your insurance company or your OMS insurance specialist in the office to see how this might break down for you. Sometimes there is a single procedure cap on your coverage. So past a certain copay, you do not owe further for the surgeons, anesthesiologits, hospital, labs etc for the single procedure. I hope that is the case for you. It does bring up a good point though. If you are preop, ask your OMS office specialist who deals with insurances to do an estimate for you before you sign on the dotted line. Dr Wests office gave me a quote, including insurance benefits applicable to the billing, at my consult. Knowing what you are facing as far as billing goes lets you plan ahead, especially given the long lead time common to this surgery. Wishing us all good luck with this!! Hugs, Fran > > hey all I just got the bill from my surgeon, total cost for him was > $8450, on the bill under insurance estimated says $5880, part I owe > $2750. I really never got a surgery before only used my insurance > for doctor visits and such, I had no idea it was gonna cost me that > much? I have blue cross/blue shield and its suppose to be pretty > good I thought. > > I guess the hospital bill will be coming soon and I have no idea how > much that is going to be, I had to get two surgeries done so I was > in the hospital twice, once for 23 hours and the other I went > directly home. > > Im going to call my insurance company up and get some more details > and ask them if this is correct but I will have to wait until I can > speak, Im wired now and talking is tough > > I was curious what some of you paid out of pocket for your surgery, > and will the hospital bill be more than the surgeon bill? I think I > have a $500 deductible and I knew I would have to pay some after > that and now im scared of the hospital bill coming. > > just wondering what some other people had to pay? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2005 Report Share Posted November 4, 2005 Hi, I am in a similar position. I have insurance with UHC PPO that covers 80% for the out-of-network surgeon (and my surgeon is out of network). I haven't received the insurance payment details (it is only a little over 5 weeks since the surgery). Some questions : 1. The hospital where the surgery was done is in-network, but, the anasthesiologist wasn't. Looks like I would have to foot 20% of his charge ( about $450). Since, the hospital is contracted, and I could not have chosen an in-network anasthesiologist, doesn't the insurance usually pay at in-network rate (100%)? 2. I am told that the insurance would pay 80% of Usual and customery charge for the surgery. My OS (and his assistant) have a charge of about $26k. The Usual & Customary charge, I fear, can be considerabily lower than what the doctor has charged, in which case I would have to pay for the difference out of my pocket. What does the maximum-out-of-pocket mean in this case? does it cover for the difference between the doctor's charges and the insurance's Usual & customary? I am really dreading having to pay a lot out-of-pocket. Looks like doctors here in bay-area charge a lot more (and did I mention that I have spent about 6.5k for my braces). Thanks, sriram _____ From: orthognathicsurgerysupport [mailto:orthognathicsurgerysupport ] On Behalf Of fran Sent: Friday, November 04, 2005 8:52 AM To: orthognathicsurgerysupport Subject: Re: insurance coverage Hi Nky_guy77 My OMS is out of network for my insurance (an employer self funded program). His fee is $14000, of which I have to pay 20% or $700. The maximum out of pocket I have with our plan is $1000. I lucked out that the hospital is in our network, so I have no copay. So I am thinking that I will just have to pay $700. At most I would pay $1000 for the surgery itself. I did not have any coverage for the braces, which was $5800. You might want to check with your insurance company or your OMS insurance specialist in the office to see how this might break down for you. Sometimes there is a single procedure cap on your coverage. So past a certain copay, you do not owe further for the surgeons, anesthesiologits, hospital, labs etc for the single procedure. I hope that is the case for you. It does bring up a good point though. If you are preop, ask your OMS office specialist who deals with insurances to do an estimate for you before you sign on the dotted line. Dr Wests office gave me a quote, including insurance benefits applicable to the billing, at my consult. Knowing what you are facing as far as billing goes lets you plan ahead, especially given the long lead time common to this surgery. Wishing us all good luck with this!! Hugs, Fran > > hey all I just got the bill from my surgeon, total cost for him was > $8450, on the bill under insurance estimated says $5880, part I owe > $2750. I really never got a surgery before only used my insurance > for doctor visits and such, I had no idea it was gonna cost me that > much? I have blue cross/blue shield and its suppose to be pretty > good I thought. > > I guess the hospital bill will be coming soon and I have no idea how > much that is going to be, I had to get two surgeries done so I was > in the hospital twice, once for 23 hours and the other I went > directly home. > > Im going to call my insurance company up and get some more details > and ask them if this is correct but I will have to wait until I can > speak, Im wired now and talking is tough > > I was curious what some of you paid out of pocket for your surgery, > and will the hospital bill be more than the surgeon bill? I think I > have a $500 deductible and I knew I would have to pay some after > that and now im scared of the hospital bill coming. > > just wondering what some other people had to pay? > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2005 Report Share Posted November 4, 2005 Sriram - I am in the Bay area as well and in the same situation. I'm going to be paying about $6,500. After you meet the out of pocket maximum you will be covered at 100% up to reasonable and customary. You're responsible for the difference. If R & C is deemed to be $6,000 and the bill is $10,000, you're responsible for the $4,000 difference in addition to any coinsurance. You can challenge the anesthesia bill to be paid at in-network due to it being out of your control but you will need to write a letter of appeal and state your argument. Hope this all helps. Thanks, Kim __________________________________ Yahoo! Mail - PC Magazine Editors' Choice 2005 http://mail.yahoo.com Quote Link to comment Share on other sites More sharing options...
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